Summer 2015 NEIGHBORHOOD R ECREATION PROGRAMS Registrations are accepted beginning 8:00 a.m. Monday, April 13, 2015 for residents within income guidelines. WEDNESDAY, MAY 20th is the FIRST DAY registrations will be accepted for NONRESIDENTS and individuals ABOVE THE INCOME GUIDELINES. This program has been developed as part of the City of Dubuque’s multi-faceted neighborhood reinvestment strategy. Development of this neighborhood-based recreation program is made possible thru Community Development Block Grant Funds provided by the Community and Economic Development Department, which results in lower activity fees. PERMIT NO. 136 DUBUQUE, IOWA LEISURE SERVICES DEPARTMENT 2200 BUNKER HILL RD DUBUQUE IA 52001-3010 PAID U.S. POSTAGE PRSRT STD |2| STAFF CONTACTS FACILITY PHONE NUMBERS Administration Office/ Park Department/Maintenance (563) 589-4263 .................... [email protected] Allison-Henderson Center.....................................................(563) 589-4300 Bunker Hill Pro Shop ............................................................(563) 589-4261 Comiskey Center ..................................................................(563) 589-4296 Eagle Point Park Toll Booth (not for pavilion reservations) ...(563) 589-4216 Miller Riverview Campground ..............................................(563) 589-4238 Port of Dubuque Marina .......................................................(563) 582-5524 Multicultural Family Center..................................................(563) 582-3681 Carnegie-Stout Public Library ..............................................(563) 589-4225 Five Flags Center .................................................................(563) 589-4254 Marie Ware, CPRP - Leisure Services Department Manager (563) 589-4263 ..................... [email protected] Dan Kroger, CPRP - Recreation Division Manager (563) 589-4310 ..................... [email protected] Steve Fehsal, Park Division Manager (563) 589-4260 ..................... [email protected] HOTLINE Tony Elskamp, CTRS, CPRP - Recreation Supervisor (563) 589-4312 ..................... [email protected] To obtain the latest recorded information on the status of activities, including cancellations and postponements, and upcoming events, call (563) 589-4386. Janna Beau, CPO - Recreation Supervisor (563) 589-4315 ..................... [email protected] NOTIFY ME Brian Feldott, Recreation Supervisor (563) 589-4316 ..................... [email protected] Visit www.cityofdubuque.org/notifyme to sign up to receive news, announcements, and cancellation alerts from the Leisure Services Department related to City recreation programs and activities via e-mail or text message. Ben Alden, Recreation Facilities Supervisor (563) 582-5524 ..................... [email protected] EASY WAYS TO REGISTER! ONLINE - BEGINS APRIL 6 Register with a MasterCard/Visa at www.cityofdubuque.org/recreation. A small convenience fee is charged by the hosting company. This fee is non-refundable. MAIL, E-MAIL, OR FAX - BEGINS APRIL 13 1) Mail to Leisure Services Department, 2200 Bunker Hill Rd., Dubuque, IA 52001-3010, 2) fill out the form at the end of this brochure and e-mail to [email protected], or 3) fax to (563) 589-4391. IN-PERSON - BEGINS APRIL 13 Drop off at 2200 Bunker Hill Rd., Monday through Friday, 8:00 a.m. - 5:00 p.m. After hours, place form and payment in sealed envelope and place in mail slot in the office door at 2200 Bunker Hill Rd. Programs limited to a certain number of participants will be registered on a first-come, first served basis. Any mail, fax, e-mail, walk-in, or drop-off registrations received prior to the registration start date, will be input at random starting the next full business day following the registration start date. You will receive a confirmation receipt within two weeks via e-mail or postal mail. Payment must be included with registration. Fees may be paid by credit card, cash, or check; make checks payable to Leisure Services Department. REFUNDS FINANCIAL ASSISTANCE A credit balance for future registrations will be provided if requested fourteen (14) days before program start date. The Leisure Services Department reserves the right to cancel programs and refund fees if registration is insufficient. To assist low income residents (residing within city limits), the Leisure Services Department does allow individuals or families to purchase swim passes, park passes and register for some Recreation Division programs/classes for 50% of fee listed in brochure. Registration must take place in the department office, with a copy of appropriate identification and current benefit card, or an income form will need to be completed. Page 2 Neighborhood Recreation Programs Playtime for Tots 3600.311 - $80 or free 3600.312 - $80 or free Age: 3-5 yrs. Age: 3-5 yrs. M-F, June 1 – July 24 M-F, June 1 – July 24 9:30 – 11:30 am, Comiskey Center 12:30 – 2:30 pm, Comiskey Center A structured recreational program for ages 3 thru 5, including activities such as games, stories, music and art, developed around a weekly theme. Children must be 3 on first day of class, toilet trained and able to take care of themselves to attend. Teacher: Nancy Schmidt. (Minimum of 5 participants must be registered to run session; maximum of 10.) Adventure Day Camp Program ADVENTURE DAY CAMP - A weeklong adventure day camp takes place in cooperation with the Four Mounds Foundation. Activities include: the Four Mounds challenge ropes course, canoeing at the Mines of Spain, ecosystem adventures at Swiss Valley Nature Center and EB Lyons Interpretive Center, as well as swimming, creek stomping, hiking, team building, games, and arts and crafts projects. The camp runs Monday through Friday, from approximately 8:10 a.m. to 3:20 p.m. Children are required to bring a sack lunch; all other supplies are provided by the camp. Convenient pickup and drop-off locations are at Lincoln School and Audubon School. We will make every attempt to offer a rain date if camp is canceled two or more days in one week. Children may register for only one week. Capacity: Limited to 25 campers per week. COST: Free to income-qualifying families that are residents of Dubuque, or $165 per camper per week. ACTIVITY # PROGRAM DATES AGE 3100.310 Week 1 June 8th thru 12th 11 - 15 years 3100.320 Week 2 June 15th thru 19th 7 - 10 years 3100.330 Week 3 June 22nd thru 26th 11 - 15 years 3100.340 Week 4 July 6th thru 10th 7 - 10 years 3100.350 Week 5 July 13th thru 17th 11 - 15 years 3100.360 Week 6 July 20th thru 24th 7 - 10 years 3100.370 Week 7 July 27th thru 31st 11 - 15 years 3100.380 Week 8 August 3rd thru 7th 7 - 10 years | 63 | www.cityofdubuque.org/recreation SEE ALL REGISTRATION OPTIONS ON PAGE 2 OF THIS BROCHURE! Programs limited to a certain number of participants will be registered on a first-come, first served basis. Any mail, fax, e-mail, walk-in, or drop-off registrations received prior to the walk-in registration start date, will be input at random starting the next full business day following the walk-in registration start date. You will receive a confirmation receipt within two weeks via e-mail or postal mail. Payment must be included with registration. Fees may be paid by credit card or check; make checks payable to Leisure Services Department. IF SPECIAL NEEDS OR ACCOMMODATIONS ARE REQUIRED, PLEASE PROVIDE INFORMATION. PLEASE PRINT & FILL OUT COMPLETELY: Make additional copies of this form as needed or provide info on second sheet. ADULT NAME: STREET ADDRESS: CITY, STATE, ZIP PHONE (home): (work): (cell): EMAIL ADDRESS (required): Interested in receiving email/text messages regarding Leisure Services and Mulitcultural Family Center Programs and Events? Visit www.cityofdubuque.org/notifyme to sign up! PARTICIPANT’S NAME M/F CHOICE BIRTHDATE ACTIVITY NAME ACTIVITY NUMBER FEE 1ST 1 2ND 1ST 2 2ND 1ST 3 2ND 1ST 4 2ND swim lesson nonresident fee Note: Patrons registering for free Neighborhood Recreation Programs section must fill out the flip side of this form. COMPLETE IF PAYING BY CREDIT CARD Credit card number: **************** Today’s date:______________________________ Credit card expiration date: ___________________ Signature: _______________________________ AMOUNT ENCLOSED Please check if address has changed since last registration. The City may take photographs and/or audio or video recordings of participants in City programs and has the right to use, for any legitimate purpose, including promotional materials produced by the City to encourage participation in the activity or program, any and all photographic images and/or video or audio recordings, including those in which I am depicted. I hereby waive all rights to compensation by reason of such use. I understand that the City does not supervise or restrict recordings of public activities by third parties. 2015 NEIGHBORHOOD RECREATION PROGRAMS -- REGISTRATION FORM FILL IN THIS FORM ON BOTH SIDES. GIVE COMPLETE INFORMATION. Registrations may be mailed or dropped off, with payment, to: Leisure Services Department, 2200 Bunker Hill Rd., OR the City Clerk’s office, City Hall, 50 W. 13th St. Leisure Services Department reserves the right to cancel programs/refund fees if registration is insufficient. Registrations accepted BEGINNING APRIL 14TH for RESIDENTS within income guidelines. REGISTRATIONS FOR ABOVE INCOME & ALL NONRESIDENTS WILL NOT BE ACCEPTED UNTIL MAY 21st. Adult name ______________________________________________________________ Today’s Date____________________ Address _________________________________________________________ City_________________ Zip Code __________ Phone #’s home ________________________ work _________________________ cell _________________________ PARTICIPANT NAME_________________________________________________ birth date ___/___/___ male __ female __ WARNING: Whoever, knowingly and willingly makes or uses a document or writing containing any false, fictitious or fraudulent statement or entry may be subject to federal prosecution. PARTICIPANT INCOME VERIFICATION REPORT NEIGHBORHOOD RECREATION PROGRAMS, CITY OF DUBUQUE, IOWA PARENT / RESPONSIBLE PERSON _______________________________________________________ 1. Including yourself, how many RELATED people are living in your household? PLEASE CIRCLE THAT NUMBER ON THE CHART BELOW, UNDER FAMILY SIZE. On that same line, to the right of the number you circled, circle one of the four ranges that shows the amount of your combined household income. Family Size A B C 1 ........................... 0 – 13,900 ............... 13,901 – 23,100 .............. 23,101 – 37,000 ............. 2 ........................... 0 – 15,930 ............... 15,931 – 26,400 .............. 26,401 – 42,250 .............. 3 ........................... 0 – 20,090 ............... 20,091 – 29,700 .............. 29,701 – 47,550 ............. 4 ........................... 0 – 24,250 ............... 24,251 – 33,000 .............. 33,001 – 52,800 ............. 5 ........................... 0 – 28,410 ............... 28,411 – 35,650 .............. 35,651 – 57,050 ............. 6 ........................... 0 – 32,570 ............... 32,571 – 38,300 ............... 38,301 – 61,250 ............. 7 ........................... 0 – 36,760 ............... 36,761 – 40,950 .............. 40,951 – 65,500 ............. 8 or more ............... 0 – 40,890 ............... 40,891 – 43,600 .............. 43,601 – 69,700 ............. If you circled the “above” range (Column D), you must pay full price for all programs. D above 37,000 above 42,250 above 47,550 above 52,800 above 57,050 above 61,250 above 65,500 above 69,700 2. What is the ethnicity of person you are applying for (check one)? oHispanic o Non-Hispanic 3. What is the race of the person you are registering for (please check one)? o White o Black/African American o Black/African American & White o Asian o American Indian/Alaskan native o American Indian/Alaskan Native & White o Native Hawaiian/Other Pacific Islander o Asian & White o Asian/Pacific Islander o American Indian/Alaskan Native & Black/African American o Other Multi-Racial 4. Is participant from a home where there is a female head of household? o yes o no 5. Is the person you are applying for a member of a household using the Housing Choice Voucher (Section 8) rental assistance program? o yes o no 6. Is the person you are applying for a member of a household on the waiting list for the Housing Choice Voucher (Section 8) rental assistance program? o yes o no Fill out this side ONLY if registering for programs in Neighborhood Recreation Section.
© Copyright 2024